ENFit^® and Medication Administration in Pediatric and PICU Populations

What to Know About ENFit^®, Medication Administration, and Accuracy

Per the GEDSA timeline, many manufacturers will transition their legacy feeding products to ENFit^®. Despite these legacy products no longer being manufactured, smaller medication doses and their route of delivery, whether oral or enteral, must be addressed when transitioning to ENFit^®. 

Concerns have been raised about medication administration and dosing accuracy in the smaller patient population, with NICU, PICU, and pediatrics being impacted the most. Two studies that have evaluated dosing with a focus on these populations are:

• Female low dose tip syringes-increased complexity of use may compromise dosing accuracy in paediatric patients
• Dosing inaccuracy with enteral use of ENFit ^® low-dose tip syringes: The risk beyond oral adapters

These studies concluded that current oral syringes used in the pharmacy are the safest.

As Supply Chain ramps up ENFit^® supplies and legacy supplies are depleted, the transition to ENFit^® will begin. If conversations with the pharmacy have not been planned in advance, one of two things can happen:

1. Pharmacy will transition to ENFit^® syringes and medication accuracy can be compromised depending on how the dose is prepared and then delivered or,
2. Pharmacy will prepare oral doses with their current supply of oral syringes and, if the dose needs to be administered enterally, the oral syringe will not connect to an ENFit feeding tube.

So, Why Transition Pharmacy to ENFit^®?

You do not have to! The transition to ENFit^® was meant for enteral feeding. Pharmacy is not part of the recommendation, but has been impacted because of connection issues between ENFit^® feeding tubes, extension sets, and oral syringes for medication delivery.

Preemptive discussions with pharmacy will allow time to develop a plan that allows pharmacy to maintain their current oral syringes, despite a pediatric unit transitioning to ENFit^® for enteral feeding. The ISMP recommended oral syringe tip is safe, accurate, and engineered incompatible with IV lines. This makes oral tip syringes the ideal solution for administering oral medications while mitigating the risk of inaccuracies.

How Can Pharmacy Continue Using Their Current Oral Syringes, Despite an ENFit Feeding Line?

Medela’s proprietary low-dose dual cap facilitates a connection between an oral syringe and an ENFit^® feeding tube/extension set. The low-dose dual cap is a PERMANENT solution to a complex problem hospital-wide.

Are "Adapters" Safe?

Medela’s low-dose dual cap is ENFit^® on one side and oral on the other, both of which feature engineered incompatibility and provide safe connections. This mitigates the risk of misconnecting to a line other than what is intended.

What if We Want to Eliminate Adapters?

It is impossible to eliminate adapters. If an entire hospital (including pharmacy) transitions to ENFit^®, adapters will be required either to draw up medications or to administer orally secondary to the large threaded tip and the moat area on an ENFit^® syringe.

Isn't it Easier to Just Transition Pharmacy to ENFit^®?

Not necessarily! The medication accuracy issues raised when delivering an oral med to a patient via an ENFit^® syringe must be considered with smaller medication doses.

What About the ENFit^® Low Dose Syringe?

If you are delivering a medication orally versus enterally, an adapter must be attached to deliver the medication in an infant’s or child’s mouth. This is because of the large threaded tip and moat area on an ENFit^® syringe. Oral adapters, including Medela’s Low-Dose Dual Cap, do not have the same accuracy as the current oral syringes that have a +/- 10% dosing accuracy with a dose as small as 0.2 ml.

The National Coalition for Infant Health states, “pediatric providers must deliver medication in small volumes to tiny patients with high levels of accuracy. The new tubing design, known as ENFit^®, could present dosing accuracy challenges…”. 

Verification of dosing validation accuracy is important prior to implementing ENFit^® in the pharmacy. The minute volumes and low therapeutic index of many medications delivered to smaller patients is a critical component to consider – one that cannot be overlooked.

How Can Medela Help?

As a member of GEDSA and a committed, early supporter of the ENFit^® connector system, Medela, to best support our customers, will continue to provide both TwistLok^® and ENFit products. While there is an industry push to convert to ENFit, there is no regulatory mandate or timing to transition to ENFit as of this blog post's original publication date.